Optum Tech, part of UnitedHealth Group, is hiring a Investigations Analyst to help protect the healthcare system. In this senior role, you will be responsible for triaging, investigating, and resolving instances of healthcare fraud and/or abusive conduct. You'll conduct confidential investigations, analyze claims data, and report illegal activities to make a tangible impact.
What You'll Do
- Conduct confidential investigations, document relevant findings, and report any illegal activities in accordance with all laws and regulations
- Review claims data, look for patterns of potential fraud, waste, and/or abuse, and interact with medical providers to request medical records for investigations
- Make determinations for pre-pay flagging and other investigative actions
- Perform audits, analyze claims data, conduct investigations, and synthesize findings into reports
What We're Looking For
- High School Diploma/GED or higher
- 3+ years of experience working in a government, legal, law enforcement, investigations, healthcare, managed care and/or health insurance environment
- 3+ years of experience in a position processing medical claims and/or investigating fraud (healthcare fraud investigations experience preferred)
- 3+ years of experience communicating complex information via phone conversations and emails to non-technical clients, providers, internal customers, outside law enforcement agencies, and executives; must have solid ability to accurately document findings in written form
Nice to Have
- Bachelor's Degree in Criminal Justice or a related field
- 3+ years of experience working in the group health business, particularly within claims processing
- Intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy and/or commercial health insurance)
- Experience with Facets, iDRS, CSP, Macess, or other claims processing systems
- Healthcare Coding Certification
- Certified Fraud Examiner (CFE) or accredited Healthcare Fraud Investigator (AHFI)
Technical Stack
- Facets, iDRS, CSP, Macess, and other claims processing systems
Team & Environment
You will join a team responsible for triaging, investigating, and resolving instances of healthcare fraud and/or abusive conduct.
Benefits & Compensation
- Annual compensation range: $60,200 to $107,400
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase plan
- 401k contribution
Work Mode
This role is open to candidates across the United States.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
